Empirical Helicobacter pylori rescue therapy: an 18‐year single‐centre study of 1200 patients

Abstract

Background: Manychangeshavebeenmadetotheguidelinesonrescuetreatmentsfor Helicobacter pylori infection due to their poor effectiveness in clinical practice.Objective: To evaluate the use and effectiveness of different empirical rescue therapies for H. pylori infection in a specialised consultation unit over 18 years. Methods:Design: analysis of a systematic, prospective, single-centre data record.Patients: consecutive patients in whom at least one H. pylori eradication regimen had failed. Intervention: consecutive rescue therapies were prescribed empirically according to the best scientific evidence. Helicobacter pylori eradication was defined by a negative 13 C-ureabreathtest.Results: A total of 1200 subjects were included. Eleven different therapies were used during the study period, being the seven most common: proton pump inhibitor (PPI)-levofloxacin (LEV)-amoxicillin (AMO); PPI-bismuth(BIS)-LEV-AMO; PPI-moxifloxacin-AMO; ranitidine bismuth citrate-tetracycline-metronidazole; classical BIS (BIS)-containing quadruple therapy; PPI-Pylera ® and PPI-rifabutin (RIF)-AMO. The effectivenessofthesecond-,third-,fourth-andfifth-linerescuetherapieswas77%, 71%,60%and58%,respectively.Thecumulativeeffectivenessafterfiveconsecutive therapieswas99.8%.Thethreemosteffectivesecond-andthird-linetherapieswere: PPI-Pylera ® (96%and82%,respectively),classicalBIS-containingquadrupletherapy (92%and89%)andPPI-BIS-LEV-AMO(88%and84%). Conclusions: Helicobacter pylori eradication can be achieved virtually in all cases by the administration of several consecutive empirical therapies. The most effective second-linestrategyistheadministrationofaBIS-containingquadrupletherapy(either classical, Pylera ® or with LEV-AMO). The most effective third-line strategy is theadministrationofanotpreviouslyusedBIS-containingquadrupletherapy.Agood alternativeasafourth-linetherapyistheadministrationofPPI-RIF-AMO-BIS.

Rifabutin for the Treatment of Helicobacter pylori Infection: A Review

“…Finally, for the present review, to the best of our knowledge the most updated in the literature, all the studies that have evaluated the efficacy of rifabutin-containing regimens for the treatment of H. pylori infection are summarized in Table 2 [ 19 , 20 , 36 , 39 , 41 , 47 , 48 , 51 , 52 , 57 , 67 , 68 , 69 , 77 , 78 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 ]. Overall, from the 3052 patients treated with rifabutin-containing regimens included in Table 2 , a mean H. pylori eradication rate (by intention-to-treat analysis) of 73% (95% confidence interval (CI), 69–78%) was calculated ( Figure 3 ).…”

“…Finally, it should be noted that rifabutin therapy was highly effective even when applied to H. pylori infection with primary resistance to clarithromycin or metronidazole (or both) [ 41 , 48 , 49 , 51 , 52 , 77 , 83 , 86 ], and even in patients with triple resistance to these two antibiotics plus quinolones [ 20 ], which is the usual scenario after several eradication therapy failures. In this respect, some authors evaluated, in the same study, different regimens after failure of two or more eradication treatments and achieved a final (overall) eradication rate of almost 100% [ 83 , 92 , 106 , 112 , 113 , 114 , 115 , 116 , 117 ]. This emphasizes the recommendation that in designing a treatment strategy we should prescribe two or more therapies which, if used consecutively, come as close to the 100% cure rate as possible [ 118 ].…”

Empirical or susceptibility-guided treatment for Helicobacter pylori infection? A comprehensive review

“…These results have been recently updated, including 1200 patients and 18 years of follow-up, and the cumulative effectiveness after five consecutive therapies was 99.8%, demonstrating that eradication can be achieved virtually in all cases by the administration of several consecutive empirical therapies, based just on the previously prescribed regimens. 119 Empirical strategy should be based on the avoidance of repeating similar eradicating schemes in the same patients during the course of different eradicating regimens. 46 In this last study, the most effective second-line strategy was the administration of a bismuth-containing quadruple therapy (either classical or with amoxicillin and levofloxacin); the most effective third-line strategy was the administration of a not previously used bismuth-containing quadruple therapy; finally, a good alternative as a fourth-line therapy was the administration of rifabutin (PPI, rifabutin, amoxicillin and bismuth).…”

“…46 In this last study, the most effective second-line strategy was the administration of a bismuth-containing quadruple therapy (either classical or with amoxicillin and levofloxacin); the most effective third-line strategy was the administration of a not previously used bismuth-containing quadruple therapy; finally, a good alternative as a fourth-line therapy was the administration of rifabutin (PPI, rifabutin, amoxicillin and bismuth). 119 Is the susceptibility-guided approach cost-effective? Several studies have evaluated the cost-effectiveness of the susceptibility-guided strategy, generally using decision models.…”

Re: Helicobacter pylori infection is strongly associated with metabolic syndrome, and weakly associated with non‐alcoholic fatty liver disease in a US Hispanic population: Public health impact

“…Smoking has been linked to both metabolic syndrome and NAFLD 4,5. Lower household income has been linked to metabolic syndrome, as well as more advanced fibrosis in patients with NAFLD 4,6.…”